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DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICESMEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL ID: 4O67PART I TO BE COMPLETED BY THE STATE SURVEY AGENCY 1. MEDICARE/MEDICAID
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id 4o67 is a unique identification number for a specific form or document.
Entities or individuals specified by the regulating authority are required to file id 4o67.
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The purpose of id 4o67 is to collect specific information or data for regulatory or compliance purposes.
The information required to be reported on id 4o67 may vary depending on the nature of the form or document.
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